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Suffering from vertigo. Feeling dizzy, tingling in neck, head and hear. CT scans and MRI done. Worrisome

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My 92 year old mother had an out of the blue spell of vertigo about 2.5 years ago. The vertigo dissipated about 2-3 weeks later. However, she is now plagued with a feeling of tingling that begins at the base of the back of her neck and goes to the top of her head, her ears become plugged and she complains of dizziness. Since we live in a very rural community I have taken her to every doctor I can find -- allergist, neurologist, ENT -- she has had CT scans and MRIs of the brain -- all of which come back negative. She has had a doppler of her carotid arteries -- though it shows they are slightly obstructed -- this was ruled out as the cause of her problem. The allergist did a scratch test which came up negative. Her cardiologist says it's not related to her heart and she has not had a stroke. Where do I go from here? What do you feel could be the cause? Please help us!
Posted Thu, 19 Jul 2012 in Brain and Spine
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for your query.

1. With the feeling of fullness in the ears, the first cause for dizziness where all tests return normal and that comes to mind is Meniere's disease which is diagnosed on the following criteria:
a. Vertigo
b. Fluctuating hearing loss
c. Tinnitus
d. Fullness in the ear
There is usually nausea and vomiting, the hearing usually worsens during an attack and the tinnitus also worsens. The course of Meniere's Disease is unpredictable.

2. You should get a PTA (Pure Tone Audiogram) to document any hearing loss. Meniere's disease usually causes low frequency hearing loss initially ( Audiogram sloping to left). She is expected to have presbyacusis (age related hearing loss).

3. Get a Tympanogram done to check middle ear pressures and Eustachian Tube function. If this Impedance Audiogram is normal, it may be Meniere's as it does not affect the middle ear. Middle ear pressure changes may also cause dizziness.

4. MRI Scans display anatomy and form, not function. The Eustachian tube is normally in a collapsed state. It can be voluntarily opened by yawning, swallowing, chewing gum, blowing your nose or performing the Valsalva maneuver. A Tympanogram and eardrum examination is more important.

5. Meniere's disease should normally respond to a salt restricted diet, acetazolamide (diamox- to be used with caution in the elderly) and betahistine (Vertin). If you do go in for another MRI, try a 3 Tesla Scan. It may pick up the subtle changes due to Meniere's Disease in the inner ear.

6. Another common self limiting cause for vertigo is BPPV (Benign Paroxysmal Positional Vertigo). It is very common after the age of 60. It is always due to change in head position.

7. Cervical spondylosis is expected at her age. It is the commonest cause of the tingling at the back of her neck and top of her head. Other causes that need to be ruled out is Calcium deficiency and Vertebrobasilar insufficiency or a TIA (Transient Ischemic Attack). Get a Lipid Profile done. Another common cause is drug induced hypotension. Orthostatic hypotension or hypertension may also be involved. Does she experience a blackout or fainting sensation during the episodes of giddiness?

8. Kindly let me know the details of the history of attacks and the results of your investigations. This will help in suggesting further treatment.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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